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Reply to: ‘What initial oxygen is best for preterm infants in the delivery room?—A response to the 2015 neonatal resuscitation guidelines.’

2016; Elsevier BV; Volume: 101; Linguagem: Inglês

10.1016/j.resuscitation.2016.01.008

1873-1570

Jonathan Wyllie,

Respiratory Support and Mechanisms

We would completely support and endorse the conclusion of Vento et al.,1Vento M, Schmolzer G, Cheung P-Y, Finer N, Solvag AL, Oei JL, Sugstad OD. What initial oxygen is best for preterm infants in the delivery room?—A response to the 2015 neonatal resuscitation guidelines. Resuscitation in press.Google Scholar that further well-designed and adequately powered randomized controlled trials such as the PRESOX and Torpido 2 are required to define the optimum initial inspiratory fraction of oxygen and subsequent oxygen saturation targets when stabilising or resuscitating preterm infants born less than 35 weeks gestation. The process for the 2015 ILCOR International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations has been described.2Morley P.T. Lang E. Aickin R. et al.Part 2: Evidence evaluation and management of conflicts of interest 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.Resuscitation. 2015; 95: e33-e41Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar For any such review process there are inclusion and exclusion criteria, which in this instance excluded unpublished articles. There was also, for publication, a time deadline for inclusion, which in this case was February 2015. The important data described by the authors3Oei J.L. Wright I.M. Craven P. Saugstad O.D. Coates E. Tarnow-Mordi W.O. Targeted oxygen in the resuscitation of preterm infants and their developmental outcomes (Torpido): A randomized controlled study.EPAS. 2015; (3130.2)Google Scholar, 4Rabi Y. Lodha A. Soraisham A. Singhal N. Barrington K. Shah P.S. Outcomes of preterm infants following the introduction of room air resuscitation.Resuscitation. 2015; 96: 252-259Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar was not available for inclusion as one remains as yet unpublished3Oei J.L. Wright I.M. Craven P. Saugstad O.D. Coates E. Tarnow-Mordi W.O. Targeted oxygen in the resuscitation of preterm infants and their developmental outcomes (Torpido): A randomized controlled study.EPAS. 2015; (3130.2)Google Scholar and one was only published in September 2015.4Rabi Y. Lodha A. Soraisham A. Singhal N. Barrington K. Shah P.S. Outcomes of preterm infants following the introduction of room air resuscitation.Resuscitation. 2015; 96: 252-259Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar The GRADE methodology utilised for the 2015 ILCOR process would tend to give a stronger recommendation when analysing multiple small randomized trials which all have the same direction of effect. One of the advantages of the 2015 process was its transparency with descriptions of reasoning and discussions.5Armanian A.M. Badiee Z. Resuscitation of preterm newborns with low concentration oxygen versus high concentration oxygen.J Res Pharm Pract. 2012; 1: 25-29Crossref Google Scholar The review found no benefit to initial inspiratory fraction of oxygen of greater than 0.65 and the recommendations were made on the basis of the ranges of inspiratory fraction used in the studies.6Wyllie J. Perlman J.M. Kattwinkel J. et al.Neonatal Resuscitation Chapter CollaboratorsPart 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.Resuscitation. 2015; 95: e169-e201Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar, 7Kapadia V.S. Chalak L.F. Sparks J.E. Allen J.R. Savani R.C. Wyckoff M.H. Resuscitation of preterm neonates with limited versus high oxygen strategy.Pediatrics. 2013; 132: e1488-e–-L1496Crossref PubMed Scopus (119) Google Scholar, 8Lundstrøm K.E. Pryds O. Greisen G. Oxygen at birth and prolonged cerebral vasoconstriction in preterm infants.Arch Dis Child Fetal Neonatal Ed. 1995; 73: F81-F86Crossref PubMed Google Scholar, 9Rabi Y. Singhal N. Nettel-Aguirre A. Room-air versus oxygen administration for resuscitation of preterm infants: the ROAR study.Pediatrics. 2011; 128: e374-e381Crossref PubMed Scopus (94) Google Scholar, 10Rook D. Schierbeek H. Vento M. et al.Resuscitation of preterm infants with different inspired oxygen fractions.J Pediatr. 2014; 164: 1322-6.e3Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 11Vento M. Moro M. Escrig R. et al.Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease.Pediatrics. 2009; 124: e439-e449Crossref PubMed Scopus (371) Google Scholar, 12Wang C.L. Anderson C. Leone T.A. Rich W. Govindaswami B. Finer N.N. Resuscitation of preterm neonates by using room air or 100% oxygen.Pediatrics. 2008; 121: 1083-1089Crossref PubMed Scopus (207) Google Scholar, 13Dawson J.A. Kamlin C.O. Wong C. et al.Oxygen saturation and heart rate during delivery room resuscitation of infants <30 weeks' gestation with air or 100% oxygen.Arch Dis Child Fetal Neonatal Ed. 2009; 94: F87-F91Crossref PubMed Scopus (115) Google Scholar The recommendation was formulated to avoid exposure to oxygen without proven benefit. However, the review also highlighted the need for evidence of the most appropriate time-specific oxygen saturation targets for preterm newborns as well as neurodevelopmental outcomes for preterm newborns resuscitated with low and high-oxygen concentrations.5Armanian A.M. Badiee Z. Resuscitation of preterm newborns with low concentration oxygen versus high concentration oxygen.J Res Pharm Pract. 2012; 1: 25-29Crossref Google Scholar An advantage of the proposed future ILCOR process is a continuous approach to evidence evaluation, which would permit inclusion of important information as it becomes available through the Scientific Evaluation and Evidence Review System (SEERS: www.ilcor.org/seers). Assessing the available evidence and publishing a peer reviewed consensus document is never intended to preclude research. The areas that still require further evidence were delineated5Armanian A.M. Badiee Z. Resuscitation of preterm newborns with low concentration oxygen versus high concentration oxygen.J Res Pharm Pract. 2012; 1: 25-29Crossref Google Scholar and are consistent with the authors' conclusions.1Vento M, Schmolzer G, Cheung P-Y, Finer N, Solvag AL, Oei JL, Sugstad OD. What initial oxygen is best for preterm infants in the delivery room?—A response to the 2015 neonatal resuscitation guidelines. Resuscitation in press.Google Scholar Academic conflict of interest: Co-author of Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Also present Co-chair of ILCOR Neonatal Task Force. No financial conflict of interest.